Comptroller audits find NY Medicaid overpaid $42M

New York’s Medicaid program was hit by more than $42 million in improper or excessive payments due to delays in providing information to an electronic system, according to two state audits.

The audits by the state comptroller’s office said data problems and delays in posting information to eMedNY, New York’s Medicaid claims processing system, caused $36 million in improper payments and$6.3 million in overpayments.

“New York state has the largest Medicaid system in the country,” DiNapoli said. “Too many of our audits have found that Medicaid dollars are improperly spent or wasted, because safeguards were not in place to catch problems.”

The audits looked at whether the Department of Health made improper premium payments to Medicaid managed care plans for “dual-eligible” enrollees, or members receiving both Medicare and Medicaid.

Department of Health regulations state that dual-eligible recipients shouldn’t be enrolled in managed care plans, since premium payments normally exceed what Medicaid would pay for coinsurance and deductibles.

The first audit identified about 271,000 unnecessary Medicaid payments totaling $111 million made on behalf of 45,000 ineligible Medicare recipients.

If Medicaid paid only deductibles and coinsurance, the total payments would have been $75 million, indicating $36 million was paid improperly.

The improper payments resulted from delays in posting Medicare data to eMedNY and delays in removing those individuals from managed care plans once information was posted, according to the comptroller.

In a second audit covering a six-month period ending on March 31, 2011, DiNapoli’s office found about $6.3 million in suspected overpayments, including $3.2 million that has been recovered.

“While some money has been recouped,” DiNapoli said, “this system must work better for the taxpayers of New York.”